Term
How can angina symptoms be described ?
How is it caused?
non pharmacologic choices ? |
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Definition
Angina feels like a squeezing of the heart.
It is a result of myocardial ischemia. A common result of atherosclerosis. Other causes include severe stenosis, anemia, myopathy, tachycardia.
Aggresive lifestyle intervention,
Revascularization (PCI - percutaneous coronary intervantion aka coronary angioplasty) angiogenesis if failure of PCI or lifestyle mods. |
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Term
Drug classes to prevent angina.
What should choice be based on ?
Which drug (in one of the aforementioned classes) should be avoided? |
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Definition
CCBs, BBs, long acting nitrates all usable and efficacious.
Choice dependent on patient specific factors.
Avoid short acting nifedipine. |
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Term
Acute treatment of Angina
include dosage form, how to use them, and if discomfort persists. |
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Definition
Acute treatment
use either:
-Nitroglycerin (NTG) SL tabs
-Nitroglycerin (NTG) spray
If after 5 minutes of use discomfort continues, contact 911, then take another dose. If after the second dose discomfort persists, use a 3rd dose. Then wait until ambulance arrives. |
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Term
| Improving mortality in patients with stable angina. Unless contraindicated, qhat drugs ? |
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Definition
| Unless contraindicated: use antiplatelet, statins, ACEI |
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Term
Acute/chronic Angina treatment mechanism and their side effects:
Nitrates -
BB -
CCBs - |
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Definition
Angina treatments and their side effects:
Nitrates - Venodilator reducing preload therefore myocardial oxygen demand.
Long acting frequently cause headaches. Patients should SIT to avoid sycope.
BB - Decreases HR, contractility & BP, all reducing myocardial oxygen demand
CCBs - nindihydropyridines (cerapamil and diltiazem) decrease myocardial O2 demand in similar mechanism as BBs. Dihydropiridines (Nifedipine & amlodipine) arterial dilation only, which reduces myocardial demand.
Antiplatelet agents-
Statins -
ACEI - |
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Term
Drugs that reduce the risk of CV death and MI.
Antiplatelet agents-
when is one of the drugs reserved?
Statins -
ACEI -
What drugs increase risk of CV event/ MI ? |
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Definition
Drugs that reduce the risk of CV death and MI.
Antiplatelet agents- ASA & clopidogrel
clopidogrel is reserved in those who cannot take ASA
Ticlopidine used rarely because it can cause GI and hematologic effects (thrombocytic purpura)
Statins - lower cholesterol AND improves endothelial function
ACEI -
Drugs that increase risk of CV event/ MI: NSAIDS, hormone therapy, |
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Term
Using anti anginal agents:
How should nitrates be used to avoid tolerance ?
What pulse should be the goal for BBs?
How should BBs be discontinued?
When should BBs be avoided?
When to avoid ACEIs? |
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Definition
Nitrate users should ensure to a 10-12 hours nitrate free period to avoid tolerance. Good idea to use it at night.
Titrate BBs so pules is 50-60 BPM
Taper BBs over 10-14 days as abrupt therapy precipitates anginal symptoms
Avoid BBs in pateints with (prinzmetals angina) coronary arterial spasm. Asthma, 2nd or 3rd degree block avoid BBs.
Avoid ACEIs in patients with history of HF or ventricular systolic dysfunction. If ACEI associated cough, switch to an ARB. |
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Term
Nitrates
Side effects:
Drug interactions:
Comments: |
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Definition
Nitrates:
Side effects: syncope, headache, tachycardia, dizziness, flushing
Drug interactions: see contraindications
Contraindications: ED drugs.
Comments:
- sit when taking.
- if after 5 minutes discomfort persists call 911 & take another dose, if it still persists after another 5 minutes take a 3rd dose. |
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Term
ASA
Side effects:
Drug interactions:
Comments: |
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Definition
ASA
Side effects: (NSAID): GI upset, fatigue, bleeding,
Drug interactions: increased risk of bleeding with other antiplatelet/anticoagulant agents
Comments:
less bleeding with low dose. |
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Term
Clopidogrel
Side effects:
Drug interactions:
Comments: |
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Definition
Clopidogrel
Side effects: GI upset, HA, rash, GI bleed, diarrhea
Drug interactions: PPI use may reduce plavix activity (omeprazole especially), other antiplatelet & anticoagulants increase risk of bleeding.
Comments: |
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Term
BBs:
non-selective -
selective -
Side effects:
Drug interactions:
Comments:
Which most likely to cause CNS side effects? |
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Definition
BBs:
nonselective - nadolol, propanolol, timolol
selective - acebutalol, atenolol, bisoprolol, metoprolol
Side effects: bradycardia, HoTN, impotence, insomnia
Drug interactions: nondihydropyridines CCBs(V,D), digoxin, amiodarone
Comments: -can mask/delay hypoglycemia
- discontinue over 14 days
Contraindications: 2nd/3rd degree heartblock, ASTHMA, prinzmetal angina (coronary spasm)
Propranolol - CNS side effects |
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Term
CCBs (non-DHP)
which ones?
Side effects:
Drug interactions:
Comments: |
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Definition
CCBs (non-DHP)
Verapamil & Diltiazem
Side effects: HA, bradycardia, WORSEN/ONSET of HF
Drug interactions: 3A4 substrate, inhibits metabolism of lovastatin & simvastatin, caution with inotropic drugs increases effects (BBs)
Comments:caution with HF and 2nd/3rd degree heart block. |
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Term
CCBs (DHP)
Side effects:
Drug interactions:
Comments: |
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Definition
CCBs (DHP) --> work more on periphery hence ankle edema
Amlodipine & Nifedipine
Side effects: ankle Edema, flushing, Tachycardia
Drug interactions:3A4, not as much inotropic effect b/c not as much action in the heart, more in periphery
Comments: |
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